Monday, February 9, 2009

Shrink Shop

Let's review the checklist of things I need to complete before getting pregnant:

Buy a Car

Shop for a Shrink: I predicted this would take longer than buying a car. I am so far correct.

Finish 2008 taxes: I so loathe having to do this. Isn't there another blog I need to catch up on?

I did buy the car, which should be the topic of a future post, as I learned a lot of interesting things about car safety along the way. Basically, reader's choice won out!

On my mind now is the search for a new psychiatrist. I really wanted to find someone who specializes in treating pre-natal depression and anxiety and have it set up before my FET. I'm finding out a lot of good reasons for this.

It took me 3 weeks to do the research and make an appointment.

Once I did make the appointment today, it will be another four weeks before I could actually get in to see this specialist. I don't even know yet if this doctor will work for me.

The lesson is that this process takes a long time, which I already knew. If you have any inkling that you think you will have a problem with mental health during your pregnancy, you do want to find your psychiatrist before getting pregnant. If you are like me and thought that once you got pregnant that all your depression about not having children would vanish in a wave of euphoria, then you are going to be in big trouble. Once my mental health took a turn for the worse after the euphoria of initially finding out I was pregnant passed, I did not have the capacity to go through the search for a psychiatrist. I did try, but gave up after a few discouraging phone calls. Now that I am sane again, I can handle what seemed, when I was pregnant, an overwhelming task. I truly was sick at the time and needed help right away, not two months later. It's a sad story, but this is the reality of our ailing healthcare system.

Let's review the crap process I've already gone through in my search. First, I asked my RE for recommendations for psychiatrists in my area that specialize in prenatal depression. It took him a week to find those and get back to me. Of the two, one woman psychiatrist said that prenatal depression was not her specialty, but she could see me. She also gave me an off comment like, sounds like you just want medication management and not therapy, and that's not what I do. I didn't like how she misinterpreted my questions, so she was scratched off the list. Plus she is out of network with my insurance. With the next psychiatrist, I first had to get through the misinformation from his newly hired receptionist to find out that he does have some patients with prenatal depression he is currently treating, though it is not specifically his specialty. The problem with this guy is that he is out of network with my insurance and insanely expensive, $150 for half an hour. I'm always amazed that out of network shrinks won't work with you on their price. Scratched off the list. Next, take on the in network list of psychiatrist.

First, I called my insurance company to get a list of psychiatrists in my area. I had to endure the, "are you contemplating suicide?" before I could even ask my question. I was then given a bunch of misinformation and sent a list of psychologists, not psychiatrists that I had asked for. I decided just to do the search myself than frustrate myself with incompetent "mental health specialists" at my insurance company.

I printed off a list of all the psychiatrists within 25 miles of my house who are covered by my insurance and narrowed the list of 54 down to 6 women psychiatrists in my town or adjacent towns. Of the six, one had closed her practice, and four worked with other specialties. I did find one psychiatrist who does specialize in treating prenatal depression and anxiety, but only after talking with another male psychiatrist's office. I called her office four times in a week and did not get a response. I was a bit frustrated, but decided if I didn't get through this week, then forget it. Maybe they were on vacation last week, I don't know. I would have given up on this female psychiatrist, but I was going to make an appointment with another male psychiatrist who I was told specializes in prenatal depression by his receptionist. However, I had to call yet another person to actually make the appointment. When I talked to the appointment lady, she referred me to this other female psychiatrist instead.

Did I lose you yet? Yes, it was complicated and I'm going into all the detail to show how much research one has to do to find the right person. When you are in the throwes of serious depression and trauma, you can't deal with this overwhelming task. My other support fell apart too, because people, including my husband, were not used to seeing me my normal assertive-take-charge-in-control-self fall apart to a whimpering mass of protoplasm. I related this whole shrink shopping story to my husband, and he said he would have given up after the 4th psychiatrist. I called a total of NINE psychiatrists before finding the one, and I have not even interviewed her yet to find out if she will be a good match!!

Don't depend on your fertility clinic to help you out either. While my new RE did try to get me the proper referrals, which is more than I can say for my old RE who just pawned me off on their clinic psychologist who I didn't care for, the referrals were not psychiatrists who specialize in prenatal depression or postpartum depression! If a fertility clinic has their own psychologists, they specialize in treating the stress and depression that comes with infertility, not after you get pregnant. I believe the assumption, which was mine also, is that all would be well after getting pregnant. There are women like me, who have problems with all the hormones of pregnancy and it affects their mental health. As far as I can tell, it's similar to post-partum depression, though the actual mechanism in the brain is probably a bit different.

When I was pregnant and depressed and anxious, the doctors I was seeing either 1) ignored my depression or 2) judged me for not taking the Prozac I was prescribed. When an anti-depressant makes you more anxious, you don't have much motivation to take it! Hence the reason I am insisting on seeing a specialist in the area of prenatal depression and anxiety. If a doctor had said to me, "here is the specialist you should see that is covered by my insurance" that would have helped a lot. But out of three doctors who saw the state I was in, none of them gave me any recommendations for a psychiatrist. You truly have to be your own mental health advocate, and when you are mentally unhealthy, all you want to do is crawl under the covers and stay there. I did the best I could at the time, and I really wasn't seeing the right people. I hope I don't go through the same thing again, but I'm going to be prepared this go around.

Ed note: Upon proofreading this for the 10th time, I finally noticed that I started off with "before getting pregnant" not "before my FET". I was going to change it, but then I thought, how cool is that?

6 comments:

I hear you on the search process with mental health professionals...a good match is so critical to success.

And although I do not have any experience with possible postpartum depressions after a pregnancy, I do know that my systems after the IVF hormones wore off were identical to postpartum - confirmed by my therapist.

I also am angered by the lack of follow-up (or at least awareness of) mental health care in this infertility "industry". When we got our BFN and had the phone consultation with the doctor that same day - the day were you are sobbing so hard you can barely speak - it would have been so helpful if there was an option to speak to a mental health professional at the moment. Then, it would have been even more helpful if he/she talked about follow-up care. But no, instead I felt dropped. No other way to really put it.

I really hope after all your efforts, this person is a good fit for you.

And, yes, I did catch the "when I'm pregnant" comment and thought "cool" as well :-).

i think it is wise for you to begin a relationship with a therapist before getting pregnant. sorry it's been so difficult to find someone to see. reading what you've gone through, i wanted to add a few thoughts. feel free to take them or leave them, but since I work in the field, thought i'd throw in my two cents.

it's pretty well-established in the literature that women going through IF are at higher risk of peripartum and postpartum anxiety and depression, so people who are working in the field with pregnant women should know this. i'm bummed that you did not find this understanding when you were going through difficulties last time.

one likely place to find some good therapists is in a women's health center - often housed in a major med center. they likely won't ONLY treat peripartum depression, but will see it often enough to be familiar with the issues, interplay of hormones, prior losses, infertility treatments, etc. At the medical center I work in, we have a psych center just for women's reproductive health issues - so it's mostly post and peripartum depression/anxiety, grief issues, etc (most of the IF people see their RE's psych team).

also, i know you've narrowed your search to psychiatrists, but i did want to put in a good word for clinical psychologists. we actually have more years of specialized training than an MD (remember 4 of their 7 years of training is in basic science - not specializing in psych. By comparison, phd's have had 5-6 years of grad training in clinical psych and will likely have 1-2 years more postdoc training). some MDs go on to do advanced training, and some of them are VERY good, but this is not true across the board. I work with psychiatry residents in their final year of training and the difference between them and the final year psychology phd candidates is striking. the downside is that you would need an MD then to manage meds if you'll be taking them during pregnancy, so that would be an additional once/month appt. But in terms of quality of therapy, the clinical psychologists have much more training in what to do with patients in the room, apart from med management (cognitive therapy in particular might be very very helpful for the trauma, depression, and anxiety issues that may come up for you).

hopefully you'll click with the one person you've identified and she can be both med and therapy all rolled into one, but if not, you might consider widening the search a bit. depending on how large a metro area you live in you may or may not find someone who solely specializes in peripartum/antenatal depression, but you should be able to readily ID someone with experience using evidence-based strategies to treat PTSD, depression, and anxiety in women following infertility/loss/trauma.

Holy pain in the ass on finding a psychiatrist!! I had enough trouble finding a therapist and this sounds so much more intense!! I hope the one that you have the appointment with turns out to be great so you can feel comfortable that you have a great support system in place when you get pregnant again.

Love the new wheels and I feel you on the taxes. I think I'm pretty prepared for those, but it is still alot of work to pull it all together. Good luck!!

love the fact that you're wriitng before getting pregnant - I so want you not only to get pregnant but to have a perfect expereince free of depression or anxiety, and totally admire that you are looking for a therepist early, it's so admirable that you can actually acknowledge your feelings and get help, so many of us are just not capable of that kind of deep reflection. Bravo

smart girl!! I so hope you find the right person. I had no idea any of this stuff existed (pre/post partum depression) until you get a taste of it.

do specialists normally do both pre and post partum depression or are they entirely different? if they are similar fields what about asking holistic midwives/douhlas for their post/p contacts? they are usually more aware and sensitive to women's needs.